A midline diastema usually is part of normal dental development during the mixed dentition. However, several factors can cause a diastema that may require intervention. An enlarged labial frenum has been blamed for most persistent diastemas, but its etiologic role now is understood to represent only a small proportion of cases. Other etiologies associated with diastemas include oral habits, muscular imbalances, physical impediments, abnormal maxillary arch structure, and various dental anomalies. Effective diastema treatment requires correct diagnosis of its etiology and intervention relevant to the specific etiology. Correct diagnosis includes medical and dental histories, radiographic and clinical examinations, and possibly tooth-size evaluations. Appropriate treatment modalities have been described. Timing often is important to achieve satisfactory results. Removal of the etiologic agent usually can be initiated upon diagnosis and after sufficient development of the central incisors. Tooth movement usually is deferred until eruption of the permanent canines, but can begin early in certain cases with very large diastemas.

The midline diastema: a review of its etiology and treatment.

Anterior spaces may interfere with smile attractiveness and compromise dentofacial harmony. They are among the most frequent reasons why patients seek orthodontic treatment. However, midline diastema is commonly cited as a malocclusion with high relapse incidence by orthodontists. Objectives: This study aimed to evaluate the stability of maxillary interincisor diastemas closure and the association of their relapse and interincisor width, overjet, overbite and root parallelism. Material and Methods: Sample comprised 30 patients with at least a pretreatment midline diastema of 0.5 mm or greater after eruption of the maxillary permanent canines. Dental casts and panoramic radiographs were taken at pretreatment, posttreatment and postretention. Results: Before treatment, midline diastema width was 1.52 mm (SD=0.88) and right and left lateral diastema widths were 0.55 mm (SD=0.56) and 0.57 mm (SD=0.53), respectively. According to repeated measures analysis of variance, only midline diastema demonstrated significant relapse. In the overall sample the average relapse of midline diastema was 0.49 mm (SD=0.66), whilst the unstable patients showed a mean space reopening of 0.78 mm (SD=0.66). Diastema closure in the area between central and lateral incisors showed great stability. Multivariate correlation tests showed that only initial diastema width (β=0.60) and relapse of overjet (β=0.39) presented association with relapse of midline diastema. Conclusions: Midline diastema relapse was statistically significant and occurred in 60% of the sample, while lateral diastemas closure remained stable after treatment. Only initial diastema width and overjet relapse showed association with relapse of midline diastema. There was no association between relapse of interincisor diastema and root parallelism.

/pdf/postretention-stability-after-orthodontic-closure-of-3u44dlgtkr.pdf

Postretention stability after orthodontic closure of maxillary interincisor diastemas

Contemporaneamente, os diastemas interincisivos centrais superiores sao vistos como um fator antiestetico sendo altamente prejudicial do ponto de vista social. O diagnostico diferencial dessa anomalia da oclusao deve ser realizado o mais cedo possivel, nao so para orientar o paciente e seus pais bem como para encetar o tratamento procurando devolver ao paciente uma estetica agradavel e o bem estar social. Na realidade o diastema mediano constitui um aspecto de normalidade durante a infância e, com o desenvolvimento da oclusao, ha um fechamento fisiologico significativo. A sua persistencia depende da etiologia que e multifatorial e geralmente esta relacionada a: discrepância dente-osso positiva, microdontia, agenesias dos incisivos laterais superiores, habitos principalmente de succao, dentes supranumerarios irrompidos ou ainda intra-osseo, hereditariedade, freio labial hipertrofico e outros. O objetivo principal desse trabalho e o de nortear o leitor com relacao a epoca (quando) e como intervir para o cerramento desse espaco.

/pdf/diastema-interincisivos-centrais-superiores-quando-e-como-2gpqrkmijo.pdf

Diastema interincisivos centrais superiores: quando e como intervir?

The aim of this case report was to present the orthodontic treatment of an adult with spaced dentition, Class III malocclusion, and open-bite tendency. A 28.4-year-old adult woman was concerned about the unesthetic appearance of her spaced dentition localized at both upper and lower arches while smiling. She had a mild tongue thrust, hypertropic upper frenum, and mild speech difficulty while pronouncing “s”. Her profile was straight with prominent lips. Molar relationship was Class III on both sides. Anterior teeth were in an end-to-end relationship. Lower dental midline was deviated to the left side. Cephalometric analysis revealed a skeletal Class III relationship with hyperdivergent facial pattern. The treatment plan included myotherapeutic exercises for the tongue thrust habit and a diagnostic set-up for closure of diastemas. A strict retention protocol was followed combined with gingivoplasty, fiberotomy, and frenectomy procedures. All spaces were closed successfully, adequate overbite and overjet relationships were obtained, and tongue thrust habit and speech difficulty while pronouncing “s” were eliminated. Clinical and cephalometric results indicated the maintenance of the treatment outcome at 6-months post-retention period.

/pdf/management-of-an-adult-with-spaced-dentition-class-iii-5dfq0vuo8f.pdf

Management of an Adult with Spaced Dentition, Class III Malocclusion and Open-bite Tendency

The prevalence of diastemas varies greatly according to age and ethnic group. In permanent dentition, it varies from 1.7 to 38%. Its etiology is multifactorial. In the deciduous and mixed dentition phases, interincisal diastemas are considered normal. There are several approaches used in the treatment of anterosuperior diastemas, which vary according to the present etiologic factor. Orthodontic treatment also has the function of treating any other associated occlusal problem and helping in the elimination of parafunctional habits. Some authors agree that orthodontic closure of diastemas without subsequent surgery for removing the abnormal labial brake greatly increases the frequency of relapse in the postretention period, while others concluded that the fibrotomy of periodontal fibers together with the retainer had a positive effect on the stability of space closure. Buccal and lingual teeth inclinations have greater tendency to relapse, while mesial and distal movements, with a period of containment, are stable movements. Removable retainers are not considered a good choice. Depending on the type of initial malocclusion, the use of retainers throughout life is recommended. Fixed retention is often cited as the only satisfactory method to promote stability at the closure of previous diastemas.

/pdf/stability-of-diastemas-closure-after-orthodontic-treatment-4bm2nio30t.pdf

Stability of Diastemas Closure after Orthodontic Treatment

A serial study of changes in spacing between teeth during the period of facial maturation, finding tendencies toward closure of buccal spaces and opening of anterior spaces. Spacing in females is equally distributed between upper and lower arches; in males it is more prevalent in the upper arch.

Characteristics and stability of spaced dentition.

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Characteristics and stability of spaced dentition.